This Bioengineering Research Partnership proposal brings together a team of experts in ophthalmic imaging and surgery to advance the state of the art in image-guided surgical interventions. We seek to overcome limitations to the surgeon's current stereo microscopic view of ocular structures by bringing optical coherence tomography (OCT) technology, which is already well accepted in ophthalmic practice, into the operating room. In modern microsurgeries of both the anterior segment and retina, the inability to distinguish delicate, microscopic tissue structures of subtle contrast, or to judge the location of surgical instruments relative to adjacent microstructures, limits achievement of surgical endpoints and patient outcomes. The overall five-year goals of the project are to develop, optimize, apply and document a clinically useful, microscope integrated OCT (MIOCT) technology for ophthalmic surgery that overcomes these limitations. We will also facilitate dissemination of this technology through commercial partnerships. We believe this technology will not only improve outcomes in current surgeries, but will also enable novel ophthalmic and other microsurgeries not possible due to current limitations in visualization. Under previous NIH support (R21EY019411), our leadership team has developed a first-generation OCT- enabled microscope that is specialized for vitreoretinal surgery, and is now undergoing clinical trials at Duke University. This first-generation system delivers unprecedented cross-sectional and three-dimensional views of the retina during surgery. It is now ready for clinical evaluation in a wider range of surgeries, including anterior segment surgery. However, the current prototype lacks real-time feedback for the surgeon, and significant advances are needed in the image acquisition, data visualization and integration, and surgical instrument design, to provide a robust and seamless platform for widespread use by ophthalmic surgeons. Our proposed project is based on multidisciplinary collaborations between biomedical engineers, surgeons and image processing experts devoted to translational advances in imaging for improved outcomes in ophthalmic surgery. The proposed Biomedical Research Partnership comprises academic and clinical faculty from Duke University Biomedical Engineering Department (BME) and Duke Eye Center (DEC), faculty at the Cole Eye Institute (CEI) of the Cleveland Clinic Foundation, and substantial support and collaboration from manufacturers of commercial OCT systems, surgical instruments, and surgical microscopes. Page 1 of 1